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Brain & Heart

CASE REPORT
Chronic systemic thrombosis of unknown

etiology with concurrent essential
thrombocythemia and recurrent stroke: A case

report

Debabrata Chakraborty* , Sadanand Dey, Nirmalya Ray, Devarati Biswas, and
Sanjay Bhaumik

Department of Neurology, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India

Abstract

Here, we report a male patient under hypercoagulable state of unproven etiology,
who used to present with recurrent thrombotic episodes since young age after he
stopped taking anticoagulant. At the age of 73, he was detected to have essential
thrombocythemia while grappling with recurrent strokes. On both occasions, he
presented with a basilar thrombus. His National Institutes of Health Stroke Scale
(NIHSS) score improved from 18 to 2 on the first occasion and from 17 to 2 sixteen
days later on the second occasion. Thrombolysis was done on both occasions, but
endovascular therapy was not done on either occasion due to chronicity of the
thrombus and remarkably improved NIHSS post-thrombolysis. For patients with
recurrent thrombotic events of undetermined etiology, an anticoagulant should be
*Corresponding author: indicated. Repeat thrombolysis can be performed without endovascular therapy
Debabrata Chakraborty within a brief gap of 16 days, even in stroke patients with moderate to high NIHSS.
(drdebabrata_c@apollohospitals.
com)
Keywords: Acute stroke; Stroke thrombolysis; Basilar thrombus
Citation: Chakraborty D, Dey S,
Ray N, et al. Chronic systemic
thrombosis of unknown etiology
with concurrent essential 1. Background
thrombocythemia and recurrent
stroke: A case report. Brain & Heart. Treating patients under a prothrombotic state of unproven etiology and presenting
2024;2(3):3741. bizarre coagulation cascade are common in clinical settings. Unfortunately, only a small
doi: 10.36922/bh.3741
fraction of patients with these conditions have an unpredictable response to thrombotic
Received: May 23, 2024 agents. Thus, managing these patients has become more challenging if they present
Accepted: June 27, 2024 with acute stroke since it is critical to strike a balance between inducing clot lysis and
controlling hemorrhagic risk. We report on a patient with an unknown hypercoagulable
Published Online: August 5, 2024
state, presenting with recurrent stroke and a large intracranial thrombus, and how the
Copyright: © 2024 Author(s). patient was managed.
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution 2. Case presentation
License, permitting distribution,
and reproduction in any medium, This case report revolves around a 73-year-old man with a history of hypertension,
provided the original work is diabetes, hypertrophic cardiomyopathy, and peripheral artery disease of unknown
properly cited. etiology, who had been taking aspirin, cilostazol, and acenocoumarol for acute limb
Publisher’s Note: AccScience ischemia for 17 years. He had stopped taking antithrombotics, except aspirin, due to
Publishing remains neutral with a lower limb hematoma. He was presented to our emergency room a year after the
regard to jurisdictional claims in
published maps and institutional acute onset of severe dysarthria, expressive aphasia, right-sided hemiplegia, and left-
affiliations. sided hemiparesis, and on the day, he detected manifestation of varying symptoms. His

Volume 2 Issue 3 (2024) 1 doi: 10.36922/bh.3741